ENLmedical.com: Conditions And Concerns: Medical Encyclopedia: Group B streptococcal septicemia of the newborn

Group B streptococcal septicemia of the newborn

Causes and Risks:

This form of infection is caused by group B strep, a bacterium which is commonly found in the gastrointestinal and the genitourinary tracts. Group B strep is responsible for about three-fourths of sepsis cases in infants. Risk factors include a mother with group B strep infection, premature rupture of membranes, prematurity, immune defects and certain congenital anomalies.Group B strep may infect the fetus through the blood stream across the placenta or through ruptured membranes as the infant passes through the birth canal. The infant may also become infected after delivery, but this produces a later appearance of illness.

Prevention:

The American Academy of Pediatrics recommends that pregnant women be tested for group B strep sometime between weeks 26 and 28of pregnancy . Another approach recommended to clinitians by the CDC is to do a prenatal screening culture at 35 to 37 weeks of pregnancy . Due to on going studies, these guidelines may change in the future. Studies suggest that giving antibiotics to pregnant women before onset of labor or membrane rupture is unlikely to prevent group B strep disease in the newborn. It is recommended to give IV antibiotic to women with positive cultures during labor. Infants should be delivered as quickly and as safely as possible after the membranes rupture. Proper hand washing by nursery caretakers, visitors, and parents helps prevent transmission after the infant is born. A high index of suspicion increases the likelihood of an early diagnosis in infants who "don't look quite right." Although early diagnosis is not preventative, it can help prevent some of the more devastating complications.

Symptoms:

unstable temperature (low or high)

poor feeding

appears unwell,stressed or anxious

breathing difficulties

grunting
flaring of the nostrils
rapid breathing ( tachypnea )
short periods without breathing (apneic episodes; see apnea ))
blue appearance ( cyanosis )
rapid heart rate (tachycardia) or extremely slow heart rate (bradycardia)
irregular heartbeat (arrythmia)
lethargy
coma
shock

Signs and Tests:

blood culture (grows group B strep)
CSF culture
urine culture (see urine collection (infants) )
Counter Immune Electrophoresis (demonstrates group B strep antigen )
CBC
chest X-ray (pneumonitis, pleural effusions )
blood gases
coagulation studies (see PT and PTT )

Treatment:

The health care provider is likely to administer one or more of the following:

IV antibiotics
ampicillin
gentamicin
IV fluids and medications to reverse shock
oxygen therapy
correct clotting abnormalities
assisted ventilation
ECMO (Extra Corporeal Membrane Oxygenator) in very severe cases

Complications:

Call Your Healthcare Provider:

This disease is usually diagnosed shortly after birth, (from birth to seven days ) in the hospital. However, if you have a newborn at home with any worrisome behavior, call your health care provider.

When IV fluids, antibiotics, and other medications must be given to an infant, the scalp provides accessible veins. In this photograph, a small intravenous catheter has been inserted in a scalp vein and fluids and antibiotics are being given.